Fallon Health reports third quarter financial results

Worcester, Mass., November 13, 2015― Fallon Health today reported a net loss of $5.1 million on revenue of $311 million for the third quarter that ended September 30, 2015. Net income includes investment and other income of $2.0 million and an operating loss of $7.1 million. For the same quarter last year, Fallon posted net income of $1.9 million on revenue of $323 million. Net income included investment and other income of $5.8 million and an operating loss of $3.9 million. Membership was 228,420 as of September 30, 2015, compared with 231,541 ending September 30, 2014.

“Results for the third quarter continue to reflect the significant headwinds facing the health care sector. Challenges include heightened expenses for prescription drugs and increased costs associated with national and state reform, including the impact of the state’s risk adjustment model,” said R. Scott Walker, Fallon Executive Vice President and Chief Financial Officer. “Fallon remains nimble, flexible and responsive as we continue to adapt to the changing needs of the market and of the diverse communities we serve.”

Richard Burke, Fallon’s Interim President and CEO, credits the company’s 38-year history of innovation for its resilience. “Through the efforts of a highly engaged and dedicated workforce, supported by a solid financial foundation, Fallon remains strongly committed to offering a variety of products and services to improve the health and well-being of members of all ages, income levels and health statuses.”

In response to marketplace challenges, Fallon has developed robust options for individuals and small businesses and for employer groups looking to self-insure. They include:

  • New “hybrid” health plans which serve individuals, sole proprietors and members within groups up to 50 employees who have asthma, diabetes or Coronary Artery Disease (or CAD). Offering $1 prescriptions, $5 co-pays and access to a disease management program, these plans focus on prevention and healthy lifestyles to improve health outcomes and to reduce costs.
  • Acquiring Group Insurance Service Center, Inc. (GISC) of Pembroke, MA through its wholly owned subsidiary, UltraBenefits, Inc. The acquisition adds 17,000 members to Fallon’s total membership and strengthens its position as a third party administrator. This expansion broadens Fallon’s commitment to employers looking for a broader range of cost-effective solutions for their employees and responds to the emerging shift toward self-funded options in the marketplace.

Also in the third quarter, Fallon was once again rated among the top health plans in America by the National Committee for Quality Assurance (NCQA)*. Fallon received a 4.5 out of 5 stars for both Private (Commercial) and Medicaid products and a 4.0 out of 5 stars for its Medicare products. In addition, Fallon earned NCQA accreditation for its HMO, Medicare Advantage and Medicaid products.

*NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measure tool in health care.

Carrie Wattu

About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.